Understanding angina

Understanding angina

Angina is chest discomfort that happens when the heart muscle is not getting enough oxygen-rich blood for what it is being asked to do. It is a symptom, not a disease in itself — a signal that one or more of the arteries supplying the heart cannot deliver enough blood flow, usually because they have narrowed.

The heart muscle is fed by the coronary arteries, a network of vessels running across its surface. Like any working muscle, the heart needs more blood flow when it works harder — walking uphill, climbing stairs, carrying something heavy, or during strong emotion. If a coronary artery is narrowed, blood flow through it may be enough at rest but fall short the moment demand rises, and that shortfall is felt as angina. Stable angina follows a predictable pattern — brought on by a similar level of activity each time, and settling with rest or prescribed medicine within a few minutes. Unstable angina is different and more dangerous: symptoms that are new, occur at rest, are getting worse, or last longer than usual suggest a coronary artery may have narrowed suddenly or become blocked, part of what clinicians call an acute coronary syndrome — the same family of conditions as a heart attack, and a medical emergency.

What angina feels like

Angina feels different from person to person. These are common descriptions patients use, offered to help you put your own experience into words for a clinician — not a checklist for diagnosing yourself.

• ●Pressure, tightness, heaviness or a squeezing feeling in the chest
• ●Discomfort that spreads to the arm, shoulder, back, neck or jaw
• ●Discomfort brought on by walking, climbing stairs, cold weather or strong emotion
• ●Breathlessness instead of pain — an "angina equivalent," more common in women, older adults and people with diabetes
• ●Nausea, sweating or light-headedness alongside chest discomfort
• ●Relief within a few minutes of resting or using prescribed angina medicine, in the stable pattern

What causes angina

Almost all causes come down to the coronary arteries not delivering enough blood flow to meet the heart muscle's demand at that moment.

Coronary artery disease

The most common cause is atherosclerosis — fatty deposits (plaque) building up gradually inside the coronary artery walls, narrowing the space blood can flow through. This build-up happens over years and often has no symptoms until the narrowing becomes significant.

Coronary artery spasm

Less commonly, a coronary artery can briefly go into spasm and narrow suddenly, even without significant plaque build-up, causing angina-type pain that can occur at rest, including at night.

Microvascular angina

In some people, particularly women, the larger coronary arteries look normal on angiography but the heart's smallest blood vessels do not dilate as they should under demand, producing genuine angina symptoms from a different mechanism.

Factors that increase the heart's demand or reduce its supply

Conditions that make the heart work harder or reduce the oxygen available to it can bring on angina even without new artery narrowing — including anaemia (a low blood count), an overactive thyroid, uncontrolled high blood pressure, and fast heart rhythms.

Who is more likely to get angina

These factors increase the likelihood of coronary artery narrowing, and are worth mentioning at your appointment:

• ●High blood pressure — very common in Nigeria and often undiagnosed, it damages artery walls over time
• ●Diabetes
• ●High cholesterol
• ●Smoking or regular tobacco use
• ●A family history of coronary artery disease or heart attack
• ●Obesity and a sedentary lifestyle
• ●Anaemia, which can unmask angina by reducing the blood's oxygen-carrying capacity
• ●Increasing age

What happens if angina goes untreated

Angina itself is a warning symptom; the complications come from the underlying artery narrowing if it is not properly assessed and managed.

Heart attack. If a narrowed artery becomes suddenly blocked, usually when plaque ruptures and a clot forms over it, the heart muscle beyond the blockage can be starved of blood and begin to die — a heart attack, and a medical emergency.

Heart failure. Repeated or prolonged reduction in blood flow can weaken the heart muscle's pumping ability over time.

Heart rhythm problems. Reduced blood flow to heart tissue can disturb its electrical activity, occasionally triggering a dangerous arrhythmia.

Reduced quality of life. Unmanaged angina can limit work, exercise and daily activity well before any of the above complications occur, which is itself a good reason to seek treatment early rather than "living with it."

How Cardiocare finds the cause

The right pathway depends on your symptoms, examination and overall health. It typically draws on some or all of the following:

• 01
  History and examination. What brings the discomfort on, how long it lasts, what relieves it, plus a general cardiovascular examination.
• 02
  12-lead ECG. A painless recording of the heart's electrical activity, which can be normal between episodes of stable angina.
• 03
  Blood tests. Full blood count for anaemia, cholesterol profile, blood sugar and thyroid function, plus specific heart-muscle markers if an acute event is suspected.
• 04
  Echocardiogram. A painless ultrasound scan showing the heart's structure and pumping function.
• 05
  Exercise or stress testing. Monitors the heart's response to controlled exertion, reproducing the conditions that bring on angina.
• 06
  Coronary CT or coronary angiography. Imaging of the coronary arteries themselves; angiography, performed in the cath lab, is the most direct way to see exactly where and how much narrowing exists.
• 07
  Heart-team treatment planning. Where more than one treatment option is reasonable, cardiologists and, where relevant, cardiac surgeons plan the best route together.

How angina is treated

Treatment addresses both the immediate symptom and the underlying artery disease driving it.

Lifestyle

Stopping smoking, regular activity within your prescribed limits, a heart-healthy diet, and control of blood pressure, diabetes and cholesterol all reduce the strain on narrowed arteries and slow further disease.

Medicines, by class

Medicine is chosen by what it does, and your clinician will discuss the right option and dose for you:

• ●Nitrates — widen blood vessels and relieve chest discomfort quickly, including a short-acting form kept for use during an episode
• ●Beta blockers — slow the heart and reduce its oxygen demand, lowering how often angina occurs
• ●Calcium channel blockers — relax the coronary arteries and reduce the heart's workload
• ●Antiplatelet medicines — reduce the risk of a clot forming on a narrowed or plaque-affected artery
• ●Statins — lower cholesterol and slow the build-up of arterial plaque over time

Procedures

Available through Cardiocare's on-site cardiac catheterisation laboratory and cardiac surgery theatre:

• ●Angioplasty and stenting (PCI) — a catheter-based procedure that opens a narrowed artery with a balloon and usually leaves a small mesh stent to keep it open
• ●Coronary artery bypass surgery (CABG) — for more extensive disease, surgery creates a new route for blood to reach the heart muscle beyond the blocked section

Living with angina: everyday self-care

• ✓Learn your usual symptom pattern — what brings it on, how long it lasts, what relieves it — so you notice when something changes
• ✓Carry and use your prescribed angina medicine exactly as instructed
• ✓Pace activity, resting before symptoms rather than pushing through them
• ✓Take preventive medicines consistently, even on days you feel well
• ✓Stop smoking, and seek support if you need it
• ✓Report any increase in frequency, severity or a lower activity threshold promptly rather than waiting for the next routine visit

Preparing for your appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Any previous ECGs, blood test results, scans or hospital letters
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

When your discomfort started, what brings it on, how long it lasts, what relieves it, and whether it has changed recently.

Questions worth asking us

• ●Is my angina coming from a narrowed artery, spasm, or something else?
• ●Do I need imaging of my coronary arteries, and what will it involve?
• ●What should I do if my usual medicine does not settle an episode?
• ●Am I a candidate for a procedure, or is medicine the right approach for now?